For Disabled People, the Elderly and their Carers in the UK

Personality Disorder - A Guide

Personality Disorder is not a single condition, It is more like a grouping
of conditions that have certain characteristics in common

Introduction

The commonest features according to World Health Organisation definitions involve forms of behaviour, perception and emotional response that are : enduring, narrow, inflexible, and significantly different from what society in general would consider "normal". In addition, such behaviours and responses are assumed to apply across "a broad range of personal and social situations"

The definition is sufficiently broad and vague for some people to question whether "personality disorder" constitutes a condition at all and the diagnosis remains a controversial one. European and American definitions of the disorder disagree on the ways in which they divide it up into types (the types mentioned here are in accordance with the World Health Organisation definitions). There are those who maintain that the diagnostic features are so broad and so vague as to make the diagnosis itself nothing more than a matter of personal opinion.

How Common is it?

The prevalence of personality disorder in the UK ranges from 2 - 13% of the population. There is a higher incidence of the condition in institutional settings such as hospitals and prisons. Research published by the office of national statistics in 1998 found that 64% of sentenced male prisoners and 50% of all female prisoners have a personality disorder.

The distribution of the types of disorder varies according to gender - antisocial types are more common amongst men, for instance, while histrionic and borderline types are more common amongst women.

What are the different kinds of personality disorder?

The Diagnostic and Statistical Manual of Mental Disorders identifies ten basic types of Personality Disorder grouped into three "clusters"

Cluster A - disorders may include people who seem odd or eccentric in some way. The types included under this heading are:

Schizoid - characterised by a lack of emotional warmth

Paranoid - characterised by grudging, suspicious, attitudes and preoccupied with rights and conspiracies.

Schizotypal - associated with mild psychotic symptoms, especially when the person concerned is under stress.

Cluster B - conditions are sometimes called "dramatic" disorders. The types included are:

Antisocial - marked by a disregard for socially acceptable forms of conduct.

Histrionic - drama making behaviours, seeking excitement.

Narcissistic - not specifically defined, but the name suggests an unusual level of obsession with the self.

Borderline - characterised by unstable moods and self image.

Those falling within Cluster B are said to have major difficulties in establishing and maintaining adequate social relationships

Cluster C - conditions are characterised by fearfulness. The two main types are:

Avoidant (withdrawal from situations because of anxiety ) and:

Dependent (showing an unrealistic need for advice, support and affirmation from others)

Are these disorders treatable?

Personality disorders may be treated with a combination of medication and psychological therapy, although some psychiatrists hold that the condition is untreatable. Antipsychotic drugs are often prescribed for self harm; "selective serotonin reuptake inhibitors" (SSRI's) such as Prozac have been used to treat "Borderline" disorder, while anticonvulsants have been used to treat aggressive behaviour. Cognitive-Behavioural Therapy (CBT) has been found to be effective in several types of personality disorder; Assertiveness training and stress management techniques can be used to control dependent and anxious disorders, while anger management techniques can be used to manage aggressive behaviour.

What if I have been diagnosed as having a "personality disorder"?

You can ask your doctor what this means. He or she should be able to give a brief general explanation of what the diagnosis is saying. Because there are so many types of personality disorder, you can ask about the specific kind of personality disorder that has been diagnosed. And because different types may call for different treatments, you can ask about what treatment is being proposed for you and about what alternatives might be possible. Remember, this information ought to be given to you as a matter of course as part of the conditions necessary to secure "informed consent" to treatment.

If you are not happy with the explanations given, remember that you are entitled to ask for a second opinion. The fact that you are diagnosed with personality disorder doesn't mean that you should be denied an explanation of what the diagnosis means, and nor does it mean that you are coping with an untreatable condition.

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